Hypotonic Uterine Contraction

Subject: Midwifery II (Theory)

Overview

Hypotonic uterine contractions are used when uterine contractions are weak and cervix dilation is sluggish. This intensity is reduced, the duration is shortened, there is good relaxation in between contractions, and the intervals are increased. The same pattern of uterine contractions during labor is maintained, however intrauterine contractions rarely exceed 35mmHg. During a uterine contraction, the patient experiences less pain and discomfort. Internal examination reveals that the cervix is not dilatable, that the membranes are typically intact, that the cervix has well adhered to the presenting area, and that there is a constricted pelvis and malposition. The mother may be worried, dehydrated, and dejected. Plan for a cesarean section if the mother has a constricted pelvis, malpresentation, or indications of fetal and maternal distress.

When uterine contractions are weak and cervical dilation is sluggish, hypotonic uterine contractions are frequently used. This is a typical type of aberrant uterine contractions that may appear at the start of labor or arise later after a variable duration of effective contractions.

The intensity is reduced, the duration is reduced, there is good relaxation between contractions, and the intervals are increased. The general pattern of labor uterine contractions is maintained, although intrauterine contractions rarely exceed 35mmHg.

Signs and Symptoms

During uterine contractions, the patient experiences reduced pain and discomfort.
When the palm is put over the uterus, there is less hardening of the abdomen during contraction.
At the site of pain, the uterine wall is easily indictable.
Internal examination reveals: Cervical dilatation (Membranes normally remain intact.)
Cervix well applied to the presenting region, with constricted pelvis and malposition.

Complication

Mother's reaction: Prolonged labor that may last several days.
The mother may be worried, dehydrated, and despondent.
Infection: if the membrane ruptures prematurely.
PPH is possible in the third stage of labor due to uterine atony.
Effect on the fetus: Fetal distress if the membrane ruptures.

Management

A thorough examination of the case is required.
To ensure if the patient is truly in labor.
To rule out CPD and misrepresentation.
To organize the management time.
If a mother has a constricted pelvis, malpresentation, or symptoms of fetal and maternal distress, schedule a cesarean section.
Reassure the mother in order to maintain morale and avoid psychological distress.
Empty the bowel with edema and encourage the mother to empty the bladder frequently; if she is unable to empty herself, catheterization should be performed.
Maintain fluid and electrolyte balance as well as nutrient requirements by infusing 5% dextrose and drinking plenty of water.
To produce healthy sleep, create a calm and peaceful environment and administer enough sedatives.
If not contraindicated, uterine contractions can be accelerated by a modest breach of the membrane followed by an oxytocin drip.
If labor does not advance despite ARM and the first regime of oxytocin drip, and there are signs of maternal and/or fetal distress, she should plan for cesarean surgery.
Keep a close eye on the maternal and fetal conditions.
If a head is low, forceps or vacuum delivery is recommended.
Continue the oxytocin flow for one hour after the baby is born. If an oxytocin drip is not started, active management of the third stage of labor can be achieved by administering Inj. Ergometrine 0.5mg IM after anterior shoulder delivery to prevent PPH.

References

Tuitui, Roshani and S. N. Dr. Suwal. Manual of Midwifery II (Intrapartum Care). Bhotahity, Kathmandu: Vidyarthi Pustak Bhandar, 2014.
medical-dictionary.thefreedictionary.com/hypotonic+labor
https://www.ncbi.nlm.nih.gov › NCBI › Literature › PubMed Central (PMC)
http://intranet.tdmu.edu.ua/data/kafedra/internal/i_nurse/lectures_stud/ADN%20Program/Full%20time%20study/Second%20year/nursing%20care%20of%20childbearing%20familly/07.%20Labor%20and%20Birth%20Complications-2%20(Distocia,%20operations).htm
https://books.google.com.np/books?id=apeLf0mPx1QC&pg=PA625&lpg=PA625&dq=Hypotonic+Uterine+Contraction&source=bl&ots=V6kpwJRtz1&sig=eq34SpyNTDBSR18jVjLO5FIXrMA&hl=en&sa=X&ved=0ahUKEwjc_6WmgcnSAhWFUrwKHZ4ADiMQ6AEIeDAT#v=onepage&q=Hypotonic%20Uterine%20Contraction&f=false
www.austincc.edu/adnlev3/labor_delivery_complications/outline_compld.htm

Things to remember

When uterine contractions are weak and cervical dilation is slow, this word is used.
This is a typical type of aberrant uterine contractions that may appear at the start of labor or arise later after a variable duration of effective contractions.
This intensity is reduced, the duration is reduced, there is good relaxation between contractions, and the intervals are increased.
The general pattern of labor uterine contractions is maintained, although intrauterine contractions rarely exceed 35mmHg.
During uterine contractions, the patient experiences reduced pain and discomfort.
Internal examination reveals poor cervical dilation, membranes that are usually intact, cervix well applied to the presenting region, and the presence of constricted pelvis and malposition.
The mother may be worried, dehydrated, and despondent.
If the mother has a constricted pelvis, malpresentation, or symptoms of fetal and maternal distress, schedule a cesarean section.
If labor does not proceed despite ARM and the first regime of oxytocin drip, and there is evidence of mother and/or fetal discomfort, she should plan for cesarean surgery.

Questions and Answers

Define hypotonic uterine contraction.

This phrase is typically used when uterine contractions are weakened and cervical dilation is slowly occurring. This is a typical type of abnormal uterine contraction that can appear at any time during labor or later after a variable number of effective contractions.

List the sign and symptoms of hypotonic uterine contraction?

The patient experiences reduced discomfort and suffering during uterine contractions.
When the hand is over the uterus, there is less stiffening of the abdomen during contractions.
When there is pain, the uterine wall is plainly discernible.
Poor cervix dilation (1 cm/hr beyond 3 cm dilatation), according to internal examination
Membranes typically hold up well.
Well-applied cervix to the part that is being seen in conjunction with a tight pelvis and an abnormal position.

Write the management of hypotonic uterine contraction?

Management:

A thorough analysis of the case must be conducted:
to confirm the patient's actual labor.
omitting CPD and misrepresentation
to organize the time under management.
If the mother has a tight pelvis, a malpresentation, or signs of both fetal and maternal distress, prepare for a caesarean section.
Encourage the mother to maintain her spirits and avoid mental illness.
Empty the bowel by edema, encourage the mother to do it regularly, and if she is unable to do so, perform catheterization.
By infusing 5% dextrose and often consuming oral fluids, you can keep your fluid and electrolyte levels balanced and meet your nutritional needs.
Create a peaceful, quiet setting and administer enough medication to promote restful sleep.
If not contraindicated, low rupture of membranes followed by an oxytocin drip can speed up uterine contractions.
She should get ready for a caesarean section if labor is not advancing after the use of ARM and the first regimen of oxytocin drip and there are signs of maternal and/or fetal distress.
Keep a close eye on the health of the mother and fetus.
When a head is low, vacuum or forceps delivery is recommended.
Till one hour following the delivery of the baby, keep the oxytocin drip going. In order to actively manage the third stage of labor if an oxytocin drip is not started, administer Inj. Ergometrine 0.5mg IM after anterior shoulder delivery.